D. Marchesoni

Gynaecological aspects of primary Sjogren's syndrome

UNLABELLED Female patients affected with Sjogrens Syndrome (SS) frequently describe symptoms such as vaginal dryness and dyspareunia; however, only a few controlled studies have regarded clinical involvement of the female external genitalia. OBJECTIVE The present study was undertaken in order to: (1) Evaluate the involvement of external genitalia in a large number of female patients affected with primary SS (pSS) by semi-quantitative methods covering subjective symptoms and clinical evaluation. (2) Compare pSS patients with a matched healthy control group (pre- and post-menopausal women were separately studied). (3) Correlate the gynaecological involvement with salivary and lacrimal abnormalities in pSS patients. METHODS We evaluated 36 patients with primary SS (18 pre- and 18 post-menopausal women) and 43 healthy controls using a questionnaire regarding vulvar and vaginal dryness and a complete gynaecological examination. Subsequently, three scores related to vulvar and cervical status plus a global score were obtained. In primary SS patients, salivary and lacrimal involvement was also evaluated. RESULTS Dyspareunia was present in 61% and vaginal dryness in 55% of SS patients versus 39% and 33% of healthy controls. No significant differences regarding gynaecological scores were found between SS patients and controls, in both pre- and post-menopausal women, nor correlation was observed between gynaecological and lacrimal or salivary involvement. CONCLUSIONS Our data suggest that although SS patients frequently complain of dyspareunia and vaginal dryness they do not greatly differ from healthy subjects in regard to some major gynaecological aspects.

Umbilical Artery Pulsatility Index in Pregnancies Complicated by Insulin-Dependent Diabetes mellitus without Hypertension

Objective: In a group of diabetic pregnant women, the umbilical artery pulsatility index (PI) was compared with both pregnancy complications and perinatal outcomes. Method: We evaluated 67 women with pregnancies complicated by insulin-dependent diabetes mellitus (IDDM), without hypertension. For the study we took the last umbilical PI value before delivery into consideration. Doppler results were not used for patient management. Umbilical artery PI was correlated with the route of delivery and the following perinatal complications: intrauterine growth retardation; cesarean sections for acute fetal distress; respiratory distress syndrome (RDS); neonatal hyperbilirubinemia; hypocalcemia; hypoglycemia; macrosomia, and neonatal intensive care unit (NICU). Results: Among the 67 diabetic patients enrolled in this study, 44 (66%) had umbilical PIs ranging from the 5th to the 95th percentile (PI mean ± SD = 1.2 ± 0.3), while 23 (34%) had PIs above the 95th percentile (PI mean ± SD = 1.6 ± 0.3). Among the group with pathologic umbilical PIs, analysis of the data revealed a significantly higher incidence of both cesarean sections for acute fetal distress and perinatal complications: RDS; hyperbilirubinemia; hypoglycemia, and the need for NICU, respectively. Conclusion: In 34% of the diabetic pregnant women without hypertension, we found increased vascular resistances. Among these patients the incidence of perinatal complications was higher, and both closer maternal metabolic control and stricter care of fetal conditions are needed.

P18.10: Assessment of the intra- and inter- observer reliability of placental vascularity using three-dimensional ultrasound and power Doppler angiography (3D-PDA)

angiogram and bilateral uterine artery embolization (UAE) was performed which stopped the bleeding. During the next pregnancy, a scan at 32 weeks showed left sided placenta accreta implanted above the level of the bladder. At 32+5 weeks she presented with ruptured membranes. Given the scan findings and high risk of haemorrhage, a classical Caesarean section above the upper margin of the placenta was performed. Due to the poor obstetric history, the placenta was left in-situ to avoid hysterectomy. Six weeks post delivery, patient presented with severe sepsis and a sinus (discharging pus) between the skin and the uterine cavity was demonstrated on MRI. The placenta was removed under ultrasound guidance. A small part was left in situ as it was still adherent. The patient recovered following the evacuation and was discharged home after five days. Acquired AVM is a rare complication of Caesarean section and can present with PPH, abnormal vaginal bleeding or menorrhagia. The diagnosis can be made on colour Doppler ultrasound and confirmed with CT angiography. Bilateral UAE in symptomatic patients can avoid hysterectomy however it is associated with an increased risk of morbidly adherent placenta in subsequent pregnancies. Successful pregnancy outcome after UAE for fibroids and congenital AV malformation has been reported however there is no data about pregnancy outcome after UAE for acquired uterine AV fistulae post Caesarean section. This case demonstrates the role of ultrasound in the diagnosis and management of acquired uterine AVM and subsequent morbidly adherent placenta.

OP33.06: Ductus venosus S‐wave/isovolumetric A‐wave (SIA) Index and A‐wave reversed flow in normal gestation

Objectives: We sought to evaluate the association of small abdominal circumference (AC < 10th percentile) at third trimester ultrasound with gestational age (GA) at delivery. Methods: All women seen at our institution from 2009 through 2011 for measurements from 28 to 34 weeks’ gestation with a singleton, non-anomalous pregnancy were included in this retrospective cohort. We compared GA at delivery, with preterm defined as <37 weeks, among three groups: fetuses with normal AC and normal estimated fetal weight (EFW; both ≥10th percentile; Group 1), small AC and normal EFW (AC < 10th percentile, EFW ≥ 10th percentile; Group 2), and small AC and small EFW (both <10th percentile; Group 3). Data are presented as medians (interquartile ranges (IQR)) and risk ratios (RR) with 95% confidence intervals (CI). Results: Of the 612 eligible pregnancies, 47.7% of the women were White, 17.2% Black, 15.4% Hispanic, 14.1% Asian and 5.7% other/unknown. The median GA at ultrasound was 32.0 weeks (IQR: 30.6–33.0) and median maternal age at delivery was 32.9 years (IQR: 28.8–36.7). A small AC was found in 10.6% of the fetuses. Compared to Group 1, fetuses with a small AC (Groups 2 and 3) had a lower GA at delivery and a higher incidence of preterm delivery. Fetuses in Group 2 were more than twice as likely to be delivered preterm than fetuses in Group 1, while the risk was more than six times higher in Group 3 compared to Group 1 (See Table). The RRs did not change appreciably after adjusting for maternal age and race/ethnicity. Conclusions: Small AC is associated with a higher incidence of preterm delivery. This effect was demonstrated even in fetuses with EFW ≥ 10th percentile. Further studies should examine factors that influence this association.

P30.09: Correlation between STIC Power Doppler impedance indices from spherical samples of the placenta and conventional umbilical artery Doppler indices in normal pregnancies

Objectives: The objective of the study was to evaluate differences in post partum bleeding, transfusion requirement and length of hospital stay in women with focal vs. diffuse placenta accreta. The same parameters were compared in women undergoing balloon occlusion vs. no occlusion of the iliac arteries at Caesarean delivery for accreta. Methods: Prospective observational study of women with suspected focal or diffuse placenta accreta on routine sonography. Follow up scans were performed as required. Surgical and histologic correlation was performed after Caesarean delivery. Independent groups t-tests and non-parametric Mann-Whitney U were used in the statistical analysis. Results: 25 women were diagnosed on ultrasound with placenta accreta, 9 with focal accreta and 16 with diffuse involvement. On average, women in the diffuse group exhibited significantly greater blood loss (P < 0.001) than the focal group and had a higher transfusion requirement (P = 0.12). There was no significant difference in hospital stay between the groups. 12 women underwent balloon iliac occlusion at Caesarean delivery, 2 of whom had focal accreta diagnosed prenatally and 10 had diffuse accreta. There were no significant differences in blood loss, transfusion requirement or length of hospital stay between the balloon vs. no-balloon occlusion groups. Conclusions: Prenatal diagnosis of extent of placenta accreta is clinically important and should guide management around delivery. Although the numbers in this study are small, no significant differences in blood loss or transfusion requirement were observable between the balloon occlusion vs. no occlusion group. Further studies are required to assess whether this is a worthwhile and cost-effective intervention in management of placenta accreta.